How America Got So Fat (And So Sick)

Renowned preventive cardiologist Arthur Agatston, MD, has devoted decades to helping Americans improve their health by trimming their waistlines and exercising regularly. His book, The South Beach Wake-Up Call, he warns that we're raising a generation that could be the first in modern history with shorter life spans than their parents'. Here, his urgent call to action.

America is fatter and sicker than ever. We compensate by taking diet pills and going on fad diets. But the fact is that our fast-food, sedentary lifestyle is trumping the advances in medical science that have been responsible for at least four decades of decreasing death rates from heart disease. The hard truth is that whatever shape health care reform ultimately takes—one payer, multiple payer, or a combination of coverages—it won't matter, because we as a nation won't be able to pay for it. If we don't make the positive lifestyle changes needed to halt and reverse the obesity epidemic now—today—our health care system will be bankrupted by the sheer numbers of sick Americans.

We call the men and women who lived through and fought in World War II the "greatest generation." I predict that our current population of adults between ages thirty and forty-five could have the dubious distinction of being remembered as the "sickest generation," or "Generation S." For the first time since I started practicing cardiology more than 30 years ago, heart attacks are on the rise for this age-group. Without immediate intervention, for the first time in modern history, we will start to see a reduction in life span. [pagebreak]

In order to fully understand why we are now experiencing an epidemic of obesity, diabetes, and other chronic diseases, it's useful to take a look back to the genesis of the fast-food, sedentary culture that's responsible for our failing health. The better we understand the origins of our toxic lifestyle, the better the chance that we can turn things around.

Our problems really began as long ago as 1873 at the Vienna World's Fair, where a dazzling new invention called the steel roller mill was debuted. Though no one realized it at the time, this machine would herald the age of "refined grains." With cheaper production and longer shelf lives, white-flour-based products became more affordable, which led to an explosion in their consumption—and the introduction of substantial amounts of "empty calories" into the American diet.

Next came two seemingly unrelated innovations that proved to be true game changers: the home refrigerator and the family car. By 1910, home refrigerators were fairly commonplace, which meant that people could stock up on food instead of shopping every day. By the 1930s, food could be transported long distances in refrigerated trucks or railway cars. This meant that people didn't need to shop locally for fresh food. Small corner markets were replaced by larger grocery stores. And once the family car became commonplace by the 1950s, no one even needed to walk to that store.

And the march of technology continued. The shelf life of already-bad-for-you baked goods became further extended with partially hydrogenated oils known as trans fats, which became widespread starting in the 1980s. Canned goods, packaged foods, and frozen TV dinners became available. And it wasn't long before the quality of the family dinner began to change dramatically, thanks to the advent of the fast-food restaurant.

Labor-saving devices—and the digital revolution—only compounded the problem, as we consumed more calories and burned off fewer of them. Which brings me to the robotic lawn mower. Generations ago, when grass had to be cut, you took out a machete and hacked it down. It was grueling work. The manual cylinder mower in the nineteenth century saved time but still took a fair amount of muscle—until it yielded in the twentieth century to the power mower that practically moved itself, followed by the tractor mower that allowed you to sit while mowing the grass. Today, you can do the job without even leaving the house. If you don't believe me, just Google "robotic lawn mower."

The effects of the fast-food, sedentary culture have become clear. We've known for many years how obesity, metabolic syndrome, and diabetes damage the cardiovascular system. But it's only recently that we've begun to appreciate how other organs are adversely affected. An analysis of 97 studies, published in the New England Journal of Medicine, found that diabetes is associated with an increase in the number of premature deaths from nonvascular diseases such as pneumonia and other respiratory diseases, renal disease, liver disease, endocrine disorders, neurological diseases such as Alzheimer's, and even suicide. It is also associated with premature deaths from many forms of cancer, including liver, pancreatic, ovarian, colon, bladder, lung, and breast, among others.

And in a 2011 study from Sweden, published in the journal Neurology, 8,534 twins who had their height and weight checked when they were in their early- to mid-forties were evaluated for dementia when they were in their seventies to early eighties. Those with a history of being overweight or obese at midlife were more likely to suffer from dementia later.[pagebreak]

So after I've given you all this bad news about the unintended health consequences of our modern lifestyle, you may think that I'm about to recommend that we all return to the forest and live like hunter-gatherers. Actually, nothing could be further from the truth. First of all, I enjoy living in my air-conditioned home, watching football games on high-definition TV, surfing the Web, and doing almost all of my shopping online. And second, we generally live better—and longer—due to technology (think medical advances and sanitation).

It's actually not technology that's the problem—it's the way we use it to deliver unhealthy calories and avoid energy expenditures. It's now absolutely clear that a healthy lifestyle—eating a proper diet, maintaining a healthy weight, and getting plenty of exercise and a good night's sleep—is the surest, safest way to prevent the downward spiral of diabetes, heart disease, and cancer. So let's do it. I don't expect you to be "perfect." As my mom used to tell me, "Perfection is paralysis." Just start making healthier choices most of the time.

1. Make a little go a long way.I'm a chocoholic who enjoys a decadent dessert. When you're confronted with one that looks too good to pass up, invoke the Three-Bite Rule. Allow yourself three bites, eating them as slowly as possible so you can savor each wonderful mouthful. Then pass your plate to a fellow diner. You'll soon see that enjoying just three bites of an indulgent dessert can be very pleasurable and that your sweet tooth is satisfied with just a small portion.

2. Counter the cocktails.What you drink in a restaurant is as important as what you eat. If you start having cocktails before you even order, the alcohol may go to your head and sabotage your willpower when it comes to making healthy menu choices. It's better to wait and enjoy a drink with your meal. Choose red wine with dinner over cocktails with sugary mixers; the antioxidants in the wine are good for you. (Check out these tips for keeping happy hour, well, happy.)

3. Eat better for less.In many cases, we've been given a false choice between promoting our health and saving money. The reality is, when you stop buying junk and purchase only nutrient-rich, high-quality food, you'll be surprised by how far you can stretch your grocery dollars.

The first rule for buying produce at a good price is to buy it fresh and in season. Berries can be dirt cheap in the summer and priced through the roof in the winter. You can also save by joining a local food co-op.

Co-ops aren't in business to make money for themselves; they're in business to save money for their members.

Buy frozen veggies and fruits. They're a terrific, convenient, price-conscious alternative when fresh local produce isn't in season. Most companies use a technique called flash freezing, in which produce is frozen immediately after it is picked to preserve flavor and nutrients.

Dried legumes, like beans, lentils, and chickpeas, not only provide high-quality protein but are also a good buy, especially when purchased in bulk. In addition to food co-ops, natural-food stores often offer the best bargains.

If you're fortunate enough to live near a reputable fish market with good prices, by all means become a regular customer. But if not, canned and frozen fish are fine alternatives. As with frozen fruits and vegetables, new flash-freezing techniques enable fishermen to freeze seafood within minutes of catching it, locking in both flavor and nutrients.

4. Tame sugar shock.If you follow the typical toxic American diet, you're consuming thirty-five teaspoons of added sugar in your food every day. To get an idea of just how much sugar that is, carefully measure thirty-five teaspoons of granulated sugar into a bowl. Then imagine eating all of it. I bet most of you are horrified at the thought, and frankly, so am I. If you eat processed foods regularly, that's how much you get in added sugars alone—in addition to all the other naturally occurring sugar in foods like fruits, vegetables, milk, and whole grains.

To reduce this toxic burden—a total of 132 pounds of sugar a year for every man, woman, and child in the United States—start reading labels. You'll find sugar comes under a variety of guises such as corn syrup, high fructose corn syrup, glucose, honey, dextrose, fructose, maltodextrin, maltose, malt syrup, molasses, sucrose, and rice syrup, just to name a few.

5. Get some sleep!Many maladies associated with our toxic lifestyle can be initiated or aggravated by the failure to get enough sleep. On the flip side, many of these health problems could probably be significantly reduced, if not averted in the first place, if we just got more shut-eye. (Check out 20 ways to sleep better every night.)

6. Stand up for health!Exercise is about as close to being a panacea as anything in the medical arsenal. Yet we're falling woefully short. Not long ago, the Christian Science Monitor reported that in some South Florida schools, walking to the cafeteria counted toward fulfilling the exercise requirement!

Any physical activity is good. But when it comes to getting moving, I've long been a fan of dog walking. A 2011 study found that dog owners were 34% more likely to get at least 150 minutes of exercise per week than nonowners. Nearly half of the roughly 2,400 dog owners in the study reported that they exercise thirty minutes a day for at least five days a week; among the nonowners, only about a third exercised that consistently. In another study from the University of West Virginia, teens were more active if their families owned a dog than similar adolescents whose families didn't.

Exercise even helps combat the oxidative stress that's created by eating fast food. Research shows that people who exercise regularly and eat a fast-food meal have more pliant blood vessels than the couch potatoes who consume the same bad meal.

How America Got So Fat20%: How much refrigerators have expanded in size over the last 35 years